THE HEALTH Service Executive (HSE) has proposed a series of radical measures to the Department of Health as part of an overall plan to tackle a projected €300 million deficit this year.
These include reductions in beds, the curtailment of A&E services and new restrictions on the issuing of medical cards and drug-cost reimbursements .
One option put forward by the executive to the department is ceasing to issue new medical cards or reimburse patients for the cost of medicines under various community drugs schemes once the official budget is exhausted.
Another is diverting €185 million earmarked this year for the development of services for the disabled, older people and in the area of palliative care. Alternatively, the executive has suggested there could be significant reductions in expenditure across the entire community health sector in a bid to deal with the deficits recorded on the demand-led schemes.
On the hospital side, the executive has proposed that beds and theatres could be closed over the summer months, although in some locations these closures could be for longer periods. It has suggested that in hospitals without A&E consultants there would be no emergency services after 8pm.
In another option, a proposal has been made that there could be a vigorous evaluation of new drugs and new technologies being used in hospitals. The executive has also advanced the idea that there should be more admissions on the day of surgery and a movement from seven-day activity in hospitals to five-day work.
The suggestion has also been made that there would be significant curtailment of overtime and the use of locums to replace staff absent during the summer months.
The executive also proposed that there should be a clampdown on absenteeism.
Informed sources said these measures were policy options drawn up by the executive for discussion with the department and that no final decisions had been taken. It is understood implementation of some of the measures - such as ceasing to issue new medical cards or reimburse drug costs - would require the department to amend eligibility entitlements.
It is also understood HSE chief executive Prof Brendan Drumm briefed Minister for Health Mary Harney on the executive's budgetary position.
A spokesman for Ms Harney said last night that the department had not received formal propoals at this stage but that the HSE had been asked to quantify the scale of what it saw as budgetary difficulties.
Further contacts are expected between the executive and the department on these issues in the week ahead. It is likely they will be considered by the Cabinet subcommittee on health later this month.